More than 800 gathered in Raleigh this week to address the opioid epidemic. Five lives are lost each day and more than 13,000 deaths occurred between 1999 and 2017 due to opioids. In addition to the heartbreak to families, the Center for Disease Control and Prevention estimates it cost North Carolina some $2.5 billion in 2017. DHHS Secretary Mandy Cohen said this public health crisis requires “all hands on deck.”
Opioids are common painkillers like oxycodone, hydrocodone and codeine, but also heroin and fentanyl. We’ve been aggressively fighting this crisis with some success. Opioid prescriptions have been reduced by 24 percent;12,000 have been treated for overdose and emergency room visits have decreased by 20 percent. More than 3,000 providers have been trained, 29 syringe exchange programs have been established and 20,000 Naloxone kits have been dispensed throughout the state. A $54 million federal grant helped achieve these results and establish effective partnerships with care providers, law enforcement, mental health, social service, treatment centers and other professionals. But the face of the opioid epidemic is transforming, and the campaign must also transform.
Secretary Cohen stated the federal grants have helped immeasurably but are only a temporary solution. Those overdosing on or addicted to opioids need more extensive treatment. Sadly, more than half those needing help don’t have health insurance. Governor Roy Cooper, addressing the summit, emphatically reinforced that fact, saying this is another compelling reason why we need to expand Medicaid.
The governor recognized that neither the House nor Senate had included Medicaid expansion in budgets they passed, adding talks are going on behind the scenes that might lead to expansion. Democrats in both chambers support the expansion and a growing number of Republicans are open to some form of expansion, but it is being blocked by Senate Republican leadership.
The major opposition has two prongs. First, and maybe most importantly, Medicaid expansion is associated with former President Barack Obama and Republicans don’t want anything that smells of Obama. There is the additional concern about costs. The federal government promises to provide 90 percent of the costs; many say the federal government is already broke and they don’t want to add to federal deficits. Further, they fear that a cash-strapped federal government will drastically reduce the 90-10 match. But 37 states, many with Republican governors and/or legislatures, have joined, convinced the benefits outweigh the risks. They also know that once a benefit has begun it never gets repealed or even greatly reduced. Congress won’t likely risk losing voters in 37 states, even if it means more deficits.
I asked Gov.Cooper if the exclusion of Medicaid expansion in the state budget was a deal breaker and he came close to saying “yes,” perhaps because last week’s legislative failure to override his “born alive” abortion bill signifies that a budget veto might prevail.
Cooper makes a pretty compelling case for Medicaid expansion, saying we could provide coverage for an additional 500,000 people, lower costs for private insurers and plan participants, while creating 43,000 new jobs.
The Opioid Action Plan that was updated at this week’s summit would benefit greatly from Medicaid expansion and make another giant step to help prevent, reduce harm and aid the access to care for our people.
Tom Campbell is former assistant North Carolina State Treasurer and is creator/host of "NC SPIN" on UNC-TV.